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Bleeding risks are preventing effective long-term treatmentDec 02, 2019
by Anirban Datta
Most of us know someone affected by cardiovascular disease, the number one cause of death worldwide. Nearly half of adults in the US suffer from congenital heart disease, arrhythmia, coronary artery disease, or another cardiovascular disease. Medication is the first line of treatment after diagnosis, but it comes at a cost. Doctors are forced to look past drug side effects because they have no alternative options. With so many affected by these diseases, patients deserve safer and more effective drug therapies.
People at risk for cardiovascular disease frequently have other preexisting health conditions like cardiomyopathy (heart muscle dysfunction), high blood pressure, high cholesterol, or diabetes. Those who are over age 65 or have a family history of stroke, particularly men, are also at an increased risk of developing a cardiovascular disease. Although 80% of cardiovascular diseases are preventable by simply managing high-risk lifestyle factors (smoking, drinking, obesity, and cholesterol), the stats show that people are not making these changes and the consequences are deadly serious.
Coronary artery disease (CAD), for instance, is the most common form of heart disease and falls under the cardiovascular disease umbrella. CAD patients have an increased risk of stroke, as the disease causes plaque to build up in arteries, blocking the flow of oxygen-rich blood to the brain. Stroke causes 1 out of every 20 deaths in the US and can leave survivors with lasting disabilities including memory loss, reduced speech, or paralysis.
Of the nearly 7 million stroke survivors in the US, many turn to surgery, lifestyle changes, and lifelong antithrombotic therapy to prevent another incident. In antithrombotic therapy, blood thinners (anticoagulants) and antiplatelets like aspirin are prescribed individually or combined for patients’ daily use. While antiplatelets prevent platelets from aggregating to form blood clots, anticoagulants reduce formation of fibrin, which binds platelets together when they form clots. Both medications prevent clot formation and growth. Unfortunately, they do not resolve preexisting clots and can also cause numerous side effects like major bleeding requiring medical treatment, bloody stool, bleeding gums, bruising, back and abdominal pain, dizziness, headaches and more.
Antithrombotic treatments are a necessity for CAD patients, but specific treatment plans vary because of the wide range of other diseases that commonly co-occur with CAD. One example of this is atrial fibrillation (AFib). AFib is known for giving patients an irregular heartbeat, but it also causes blood clots that may lead to stroke. CAD is actually a risk factor for developing Afib, and the presence of AFib can complicate the treatment of CAD.
A large number of CAD and AFib patients require combination therapy, which includes both anticoagulant and antiplatelet medications, to keep blood clots at bay. Combination antithrombotic therapies have improved outcomes in CAD and AFib patients, though they come with severe side effects and life-threatening complications, especially when taken long term.
The most concerning side effect is the high risk of internal (e.g., bleeding in the brain or gastrointestinal tract) and external bleeding from cuts and scrapes that cannot be stopped easily. Patients on antithrombotics must be careful to avoid accidental injury from common daily activities like exercise, shaving, and even flossing.
Patients with CAD and AFib are forced to tolerate these side effects because combination therapy is the best option they have to prevent stroke. Unfortunately, even this unsatisfactory course of treatment has an expiration date. After one year of treatment at most, the high bleeding risk outweighs the therapeutic benefit and patients will continue on anticoagulant medication only. Clearly, patients and their doctors are in need of a better alternative.
Drug discovery researchers are working to create safe medicines for lifelong treatment. As cardiovascular disease remains the leading cause of death globally and the need for combination therapy is on the rise, discovery and development of safer drugs is paramount to meeting this ever-growing need.
Anirban Datta is Senior Director of Discovery Biology at Verseon.
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